231 non-seminomatous germ cell tumours were analysed as to the control which could be obtained in various subtypes of the teratomas (Pugh classification) by radiotherapy. Little difference could be found in the response and survival in equivalent stages between intermediate and undifferentiated teratomas. Trophoblastic tumours gave a surprisingly high survival rate.
Vascular invasion of the testis or cord played a more important part in determining the outcome than nodal involvement. This has been incorporated in the staging system proposed. Radiotherapeutic technique must be carefully watched so that the renal hilum is included. A pyramidal field covering both iliac groups of nodes has been most successful with a low complication rate and a 3 year survival of 79% for those without radiological node involvement and 69% overa11 for radically treated cases (Stages I and II combined). Only 3 of 76 adequately treated cases recurred primarily within the abdominal field and one of these survives following resection of a “benign teratoma”.
Radiotherapy still gives the best quality survival for the least risk to life and fertility in early cases. Combination chemotherapy will probably save a high proportion of those who recur. In high risk groups such as those with bulky nodal disease cytotoxics plus surgery will probably prove superior to radiotherapy alone. Adjuvant cytotoxics seems to be indicated for T2 cases (those with vessel invasion).